AB0355 THE DIFFERENCES BETWEEN THE FIRST PREFERRED BIOLOGICAL DMARD AND THE DRUG SURVIVAL IN GERIATRIC AND YOUNGER ADULT POPULATION WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS: TREASURE REAL-LIFE DATA
Authors: E. Gönüllü, U. Kalyoncu, B. Yağiz, A. Ateş, O. Küçükşahin, Ş. Yaşar Bilge, N. A. Kanitez, M. Çinar, D. Ersözlü, R. Mercan, S. Akar, T. Kaşifoğlu, B. N. Coşkun, S. S. Koca, E. Bilgin, V. Yazisiz, E. Dalkiliç, R. Yilmaz, G. Kimyon, S. M. Türk, A. Erden, C. Bes, H. Emmungil, Y. Pehlivan, A. İ. Ertenli, S. Kiraz
Journal: Annals of the Rheumatic Diseases (2022)

Background Inflammatory musculoskeletal diseases are frequent in the elderly population, and this number is expected to increase significantly near future. The exclusion of older adults from the studies due to their age and comorbidities causes insufficient data about this population. Insufficient data cause clinicians to have difficulties using and selecting biological therapy in the elderly patient group. In real life, physicians’ approaches to the selection and use of biological disease modifying anti-rheumatic drugs (DMARDs) in the geriatric population with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have not been well studied. Objectives To compare the clinicians’ first choice of biological DMARDs in elderly and younger RA and PsA patients and investigate the drug survival of first biological DMARDs in both populations. Methods The traditional chronological age for the human to be classified in the geriatric population is ≥ 65 years (1). The TReasure web-based registry, created in 2017, is a multicenter observational cohort established to collect data on RA and spondyloarthritis (SpA) patients from the participating 17 rheumatology centers in different regions of Turkey. Physicians’ first choice biological and targeted synthetic DMARDs in younger and elderly patients with RA and PsA was evaluated using the descriptive statistical method. The survival of the first b/tsDMARDs was assessed using the Kaplan-Meier method. Results 3136 RA and 738 PsA patients were evaluated. 12% of 3136 patients with RA were in the geriatric population. In patients with RA, the first choice of biologic DMARDs was adalimumab (20.6%), followed by etanercept (19.9%), and tofacitinib (13.6%) in patients &lt; 65 years of age, while rituximab (24%) was the first choice in patients ≥ 65 years, tofacitinib (20.9%) in the second place and etanercept (13%) in the third. Of 738 PsA patients, 3% were over 65 years. Adalimumab (41.1%) was the first choice of &lt;65 years of age, etanercept (17.6%) was the second choice, and infliximab (15.5%) was the third choice, while adalimumab (28.6%) was the first choice in patients ≥ 65 years followed by etanercept (17.9%) and certolizumab (17.9%). In RA group, drug survival was significantly higher in patients ≥ 65 years (estimated median drug survival; &lt;65 age: 37.5 (34.1-41.1) months vs ≥65 age: 53.5 (24.9-82.2) months; log-rank p=0,016) (Figure 1). In PsA group, drug survival was significantly higher in patients &lt; 65 years (estimated median drug survival; &lt;65 age: 31.2 (26.4-36.1) months vs ≥65 age: 9.1 (0.4-17.7) months; log-rank p&lt;0,001) (Figure 1). Figure 1. Comparison of first bDMARD retention rates between &lt;65 years and ≥ 65 years. A: In rheumatoid arthritis patients, B: In psoriatic arthritis patients Conclusion With these findings, it is thought that in Turkey, the limited socioeconomic support in the geriatric patients has led physicians to prescribe treatments such as rituximab, which are administered in the hospital under the supervision of a physician, are relatively preferred in malignancies, and are considered to be relatively less risky in terms of tuberculosis. Adalimumab and etanercept were chosen in the first two lines in both geriatric and young populations in the patient group with PsA. While the drug survival was significantly higher in patients with RA geriatric age group than the younger group, in PsA in which tumor necrosis factor-alpha (TNF-α) inhibitors were chosen as initial therapy in both age groups was lower in the geriatric population. References [1]Kotsani et al. JCM 2021. https://doi.org/10.3390/jcm10143018 Disclosure of Interests None declared